CMS Pandemic Plan v. 3.1 Public Release Effective Date: 01/11/2021 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES This Page Intentionally Left Blank. 1 CMS Pandemic Plan Table of Contents Table of Contents Table of Contents .......................................................................................................................................... 2 1. Introduction, Purpose, and Objectives ................................................................................................... 5 1.1 Introduction .................................................................................................................................. 5 1.1.1 Scope ......................................................................................................................................... 5 1.2 Purpose ......................................................................................................................................... 5 1.3 Objectives...................................................................................................................................... 5 2 Context and Assumptions....................................................................................................................... 7 3 Concept of Operations (CONOPs) .......................................................................................................... 8 3.1 Situation Overview: CDC and CMS Pandemic Phases ................................................................... 9 3.2 National Incident Management System ..................................................................................... 11 3.3 Plans and Procedures .................................................................................................................. 12 4 Policy Response .................................................................................................................................... 13 4.1 Areas of Policy Action ................................................................................................................. 13 4.2 Issuance of Waivers and Flexibilities .......................................................................................... 14 4.2.1 Summary of Waivers and Flexibilities Available To CMS ........................................................ 14 4.2.2 Relevant Categories of Waivers and Flexibilities .................................................................... 18 4.2.3 Waiver and Flexibility Review, and the Approval Waiver and Flexibility Review and Approval Process ................................................................................................................................................ 22 4.3 Other Areas of Policy Action ....................................................................................................... 26 4.3.1 Clinical Standards and Quality Initiatives ................................................................................ 26 4.3.2 Caring For Vulnerable Populations ......................................................................................... 29 4.3.3 Provider, Program Integrity, Supplier, and Beneficiary Enrollment and Eligibility Policy ...... 31 4.3.4 Program Integrity and Evaluation ........................................................................................... 32 4.3.5 Value-Based Payment Policies (Including Quality and Financial Measurement and Performance) ...................................................................................................................................... 33 4.3.6 Accelerated and Advance Payment Programs ........................................................................ 33 4.4 Supporting Policy Activities ......................................................................................................... 34 4.4.1 (Section Intentionally Removed) ............................................................................................. 34 4.4.2 (Section Intentionally Removed) ............................................................................................. 34 4.5 Reconstitution Activities To Assess Approved Waivers and Flexibilities .................................... 34 5 Engagement of External Stakeholders ................................................................................................. 35 5.1 Scope of Stakeholder Engagement ............................................................................................. 35 5.2 Forums for Stakeholder Engagement ......................................................................................... 35 5.3 Rapid Response Correspondence Process .................................................................................. 38 2 CMS Pandemic Plan Table of Contents 5.4 Inquiry Response and Help Desk................................................................................................. 39 5.5 Internal Tracking of Stakeholder Concerns ................................................................................. 40 5.6 External Scan of Stakeholder Reactions ...................................................................................... 41 6 Operational Response .......................................................................................................................... 42 6.1 Areas of Operational Response .................................................................................................. 42 7 Direction, Control, and Coordination ................................................................................................... 46 7.1 Response Governance Structure and Administration ................................................................ 46 7.2 Pandemic Response Team .......................................................................................................... 47 8 Information Sharing and Scenario Planning ......................................................................................... 51 9 Offices and Centers’ Actions By Pandemic Phase ................................................................................ 54 9.1 Readiness and Preparedness (Phase 1B) .................................................................................... 54 9.2 Pre-Activation (Phase 1C) ........................................................................................................... 56 9.3 Activation (Phase 2A) .................................................................................................................. 60 9.4 Operations (Phases 2B – 2C) ....................................................................................................... 64 9.5 Reconstitution ............................................................................................................................. 66 10 Plan Development and Maintenance ................................................................................................... 69 ANNEX A – Acronyms and Abbreviations ................................................................................................... 70 ANNEX B – Definitions................................................................................................................................. 72 ANNEX K – Strategic Planning Framework for the Center for Medicaid and CHIP Services ....................... 74 ANNEX L – Revision History ......................................................................................................................... 88 ANNEX M – Approvals ................................................................................................................................. 90 3 CMS Pandemic Plan Executive Summary The COVID-19 pandemic has affected people and industries across the country, exacting a heavy toll on every American. The lives lost and the impact of the economic toll have touched every aspect of American life. With that knowledge and the response experience gained in 2020, CMS improved its Pandemic Plan to ensure the Agency is able to meet the needs of its stakeholders and as a result, now stands better prepared for any future pandemic events. CMS’ Pandemic plan has not simply been updated; it has been completely redesigned and provides CMS with the guidance and decision-making framework needed to best meet the needs of its internal and external stakeholders. This plan also details the steps taken to protect those on the CMS workforce who worked tirelessly to fulfill the agency’s mission in service to all Medicare and Medicaid beneficiaries and all Americans enrolled in individual or group market coverage. Readers should pay particularly close attention to Section 4: Policy Response, which details the utilization of available waivers and flexibilities, and comprehensively inventories the processes and activities that take place during a pandemic response. In addition, Section 6: Operational Response defines a response structure that brings the operational and policy components together, expediting decision-making and accomplishing the goals of the Agency’s response. This revised CMS Pandemic Plan reflects and accounts for the complex and tightly coupled systems in which CMS operations and policy decisions are made. Decisions, data, processes, partner engagements, and key actions were captured to reflect the nimbleness needed to successfully respond to the ongoing Pandemic and to ensure guidance is available for future public health emergencies. This plan